Impact of Type 1 Diabetes, Blood Pressure, and Glomerular Hyperfiltration on Kidney Injury in Adolescents

This study examined the effect of type 1 diabetes mellitus (DM1), elevated blood pressure, and glomerular hyperfiltration (GHF) on kidney damage in adolescents, utilizing two urinary markers: neutrophil gelatinase-associated lipocalin (uNGAL) and transferrin (uTransf).

The research involved 80 adolescents with DM1, divided into two groups: 42 with increased blood pressure (IBP) and 38 with normal blood pressure (NBP). Blood pressure was monitored over 24 hours, and all participants had estimated glomerular filtration rates (eGFRs) above 90 mL/min/1.73 m². A control group of 19 healthy, age- and gender-matched adolescents was included.

The results demonstrated the following:

• All diabetic participants exhibited a significant rise in uNGAL, independent of blood pressure. 
• Elevated uNGAL was found in patients with normal albuminuria, normal eGFR, and NBP. 
• Conversely, uTransf levels remained unchanged across the studied group and did not correlate with blood pressure.
• Adolescents with GHF had significantly higher levels of both uTransf and uNGAL. 
• Notably, GHF was present in patients with normal blood pressure.
• Among patients with IBP, triglyceride levels were significantly higher (r=0.247), and a longer diabetes duration was also noted (r=0.264).

To conclude, diabetes is a primary risk factor for early kidney injury; however, elevated blood pressure does not appear to cause kidney damage in the initial stages of DM1. The increase in uNGAL serves as an early indicator of kidney injury, even in cases of normal albuminuria, eGFR, and blood pressure. GHF may indicate early diabetic kidney involvement. 

Source: Soltysiak J, Ostalska-Nowicka D, Mackowiak-Lewandowicz K, Skowronska B, Fichna P, Stankiewicz W, Zaorska K, Zachwieja J. Early kidney damage in diabetic adolescents with increased blood pressure and glomerular hyperfiltration. Minerva Pediatr (Torino). 2024 Feb;76(1):37-45. doi: 10.23736/S2724-5276.20.05812-0. Epub 2020 Aug 4. PMID: 32748608.